Feel like someone's poking a sharp pencil into your heel? This might be what's to blame

By Sam Downing| 9 months ago

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There's nothing glamorous about foot pain, but it's an all too common problem

There's nothing glamorous about foot pain, but it's an all too common problem — especially a dull, persistent ache that blossoms in the middle of your heel.

It used to be thought heel pain was caused by bruising or bone spurs, but Sydney sports podiatrist Dr Brenden Brown tells Coach the cause is more straightforward.

"Most heel pain is some form of change to the large tendon that travels in the bottom of the foot and up the back of the heel — tendons hate change," says Brown, founder of A Step Ahead Foot + Ankle Care.

Those tendons are your plantar fascia, and (like your laziest coworker) they pitch a fit when you give them something new to do.

"The moment you massively change your activity over a short period of time, they get really sore and angry," Brown explains.

That activity can range from running on worn-out shoes, through to those extra HIIT classes you're squeezing into your current health kick — or more mundane activities.

After Christmas, Brown saw an Englishwoman woman struck down by heel pain caused by long days spent gift shopping in thongs she wasn't used to wearing, ticking off her plantar fascia.

"We ockerised her," he jokes. "A different kind of shoe can do it. That change is enough."

Plantar fasciitis (irritation of those plantar fascia) is the most commonly diagnosed form of heel pain, but Brown says there are several different types — which all follow similar treatment patterns.

First, fix your footwear

"Wear really good runners — firm on the base with some cushioning, but quite structured," Brown advises, adding that his preferred brands (none of which he's paid to endorse) include Asics and New Balance.

Once you find quality shoes, Brown says you need to wear them from first thing in the morning until last thing at night, until your heel pain goes away.

"It's like having a broken arm. If you had a cast you wouldn't take it off when you got home," he points out.

A few years ago it was so hot to ditch shoes altogether and go barefoot — or don shoes with soles as minimal as possible — but Brown is relieved that trend has faded. Not because barefoot is inherently bad, but because most people's bodies just aren't suited to it.

"You have to have really good foot mechanics," he says. "There are people who run barefoot who have fabulous results. But the problem is a vast majority of people aren't those people."

FYI, you're not doing your feet any favours if you're still schlepping around in the same runners you were wearing when Abbott was PM. Brown says moderately active people (those who, say, run or hit the gym a few times a week) should replace their shoes every six months — more often if you're highly active, less often if you're more sedentary.

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Fix your foot

"The next thing we look at the barefoot posture, [whether it's] rolling in too much or out too much," Brown continues.

If the foot isn't moving the way it should be, it'll often be corrected using insoles or orthotics.

"The evidence is really good for heel pain and orthotics — the research now says these are a fairly solid treatment," Brown says, though he cautions they won't correct everyone's feet.

"However for a good majority of the population, particularly if you've got a very flat foot, an orthotic will be helpful."

Strength, not stretching

For years the go-to fix for heel pain was stretching out tight calf muscles, but Brown says that podiatrists have now learned that treatment is more likely to irritate the plantar fascia. Now, they're more likely to be fixed via isometric exercises — that is, static holds that build up strength.

"For example, holding onto something then going up onto your toes as high as you can, then staying there as long as you can — a minimum of 45 seconds but up to two minutes," Brown advises.

He says isometrics are potent pain relievers not just for feet, but also for hip and shoulder problems.

"Each time you do one it's almost like taking a Panadol."

How fast will heel pain go away?

Depends how long it's blighted you.

While most people who come in with heel pain have only experienced it for a few months, Brown says his "record" is a highway patrol officer who'd endured hers for 10 years.

"Ten years!" he says. "That took us two months to get rid of, and that was really active therapy — using modalities in the clinics, isometrics, orthotics, all that stuff."

He advises seeing a podiatrist as soon as heel pain flares up, which will make it more likely to clear up quickly.

"The moment you start to feel heel pain, get into those treatments," he says. "That recipe of those three things — the shoes, the insoles, the isometric holds — need to be done together."